正后侧入路与外侧入路治疗儿童肱骨髁上骨折的疗效比较

The effects of two kinds of operative approaches in the treatment of humeral supracondylar fracture in children

目的总结两种手术入路治疗儿童肱骨髁上骨折的疗效,为临床治疗儿童肱骨髁上骨折的手术入路选择提供参考。方法对60例GartlandⅢ型肱骨髁上骨折患儿采用随机抽样方法分别予正后侧入路(A组,30例)和外侧入路(B组,30例)两种手术入路进行治疗。记录切口显露时间、切口闭合时间和手术时间,并依据Flynn标准对肘关节功能疗效进行评价。结果切口显露时间:A组为(14.48±1.33)min,B组为(10.27±1.28)min;切口闭合时间:A组为(20.60±1.83)min,B组为(17.00±1.36)min;手术时间:A组为(80.27±3.16)min,B组为(67.50±2.10)min。B组的切口显露时间、切口闭合时间、手术时间均短于A组,差异具有统计学意义(P<0.05);肘关节功能评定A组优良率为73.3%,B组为93.3%,B组术后肘关节功能优于A组(P<0.05)。结论对于GartlandⅢ型骨折且手法复位困难的患儿,切开复位克氏针内固定治疗儿童肱骨髁上骨折是一种可行的方法。经肘关节外侧入路在切口显露时间、切口闭合时间、手术时间均短于正后侧入路,且术后肘关节功能较后侧入路佳,可作为更为有效、可靠的选择。

Objective To compare and analyze the therapeutic results of humeral supracondylar fracture by two kinds of operative approaches. Methods Sixty cases with humeral supracondylar fracture were operated by using posterior approach( Group A,n = 30) and by using lateral approach( Group B,n = 30). The exposure time,the closing time and the operation time were recorded and the function recovery was evaluated according to Flynn joint elbow function system. Results The exposure time was( 14. 48 ± 1. 33) min in group A and( 10. 27 ± 1. 28) min in group B; The closed time was( 20. 60 ± 1. 83) min in group A and( 17. 00 ± 1. 36) min in group B; The operation time was( 80. 27 ± 3. 16) min in group A and( 67. 50 ± 2. 10) min in group B. The exposure time,the closing time and the operation time were shorter in group B than those in group A. 73. 3% patients showed excellent or good results in the function of elbow joints in group A and 93. 3% in group B,with a significant difference between the two groups( P < 0. 05). Conclusion It is a practical approach to use open reduction and internal fixation with kirschner pin for patients with Gartland Ⅲ humeral supracondylar fracture who are difficult in performing manipulative reduction. The effect of the surgery by lateral apporach is better than that by posterior approach for children with humeral supracondylar fracture.